At every Girl Scouts meeting, Christmas concert, soccer field and swimming pool in Kentucky lies a trend that is easy to spot. It doesn't have to do with the Toms on the children's feet or the feathers affixed to their hair. It's the fact that every third child in Kentucky is overweight, and many of them are obese. As they stand in front of the crowd or struggle to swim to the other side, the problem is plain. Its consequences are not so plan, but are far-reaching.

Kentucky has the third-highest childhood obesity rate in the country and the seventh-highest rate in adult obesity, Trust for America's Health's "F as in Fat" report shows. Sixty percent of Kentucky women and 80 percent of men living the state are either overweight or obese.

CHILD OBESITY RATES from Trust for America's Health

Estimates show that one in three children who were born in the year 2000

will develop Type II diabetes at one point in their lives, in large part because of the food choices they make. "We're also seeing lots of heart indicators, like high-blood pressure, high lipids and cardiac changes, in kids that are overweight," said Dr. Christopher Bolling, a pediatrician in Kenton County. "And we're seeing a lot of other issues like liver disease and kids with orthopedic problems."

Obese children can also have breathing problems like sleep apnea and asthma. They struggle with low self-esteem and the depression that can result from it. And they are the first American generation expected to live a shorter life than their parents. "They're taking medicine we used to give to old people," said Duff Holcomb, the schools nurse in Laurel County. "They're 15 and 16, so what are they going to be like when they're 36?"

The issue stems from "a perfect storm" of factors, said Elaine Russell, the state's obesity prevention coordinator. "Our food is high in calories with little nutrients," she said. "A lot of physical education has been taken out of normal daily routines."

And food is everywhere, from billboards to unexpected places like cash registers at T.J. Maxx and Office Depot, Russell said. One study found kids see about 4,000 television commercials advertising food each year. During Saturday morning cartoons, they see a food ad nearly every five minutes, and about 95 percent are pushing food with poor nutritional value. "And it's not just TV," Russell said. "Look at all the billboards, look at the Internet, look at your packaging, with characters that say, 'Come see me and do the Web game.'"

The variety of food is also staggering, Russell pointed out. "Look and see how many Oreos there are. It's not just Oreo or double-stuffed. There's also ones with mint and peanut butter. How many different chips? How many different sodas? Our choices are so unlimited."

Halloween candy displays are already set upin grocery stores, pharmacies and other storesacross the state. (Photo by Tara Kaprowy)

So, it's easy for children to make the wrong choices. Almost 40 percent of the total calories consumed by 2- to 18-year-olds are in the form of empty calories, meaning solid fat and added sugars. Next to Mississippi, Kentucky youth drink the most soft drinks in the country — up to 89 gallons per person, according to information researchers at the University of Kentucky's Nutrition Education Program compiled from the USDA's Food Environment Atlas. Meanwhile, just 17 percent of Kentucky high school students reported eating fruit and vegetables five times per day over a week's time, the amount recommended by the United States Department of Agriculture.

Children adopt bad eating habits from their parents, who "gatekeepers" of the kitchen, Russell said. "If Mom and Dad are feeding you [junk food] then you tend to eat that because that's what available to you."

Parents blame busy schedules and lack of time — and they are busier, in large part because both parents work in most households. Also, many of today's parents either don't like to cook, or can't.

Debra Cotterill teaches cooking classes for the University of Kentucky's Nutrition Education Program and is often shocked at the decline in cooking skills. "There's people out there who have said to me that they literally did not know how to boil water," she said. "I've also met people who live on candy and packaged chips because they don't know how to cook." Ginger Gray, director of food services in Kenton County Schools, was not surprised, saying many of today's parents "are a generation of microwave users."

Exacerbating the problem is a lack of exercise. Gone are the days of students heading to the change room to get ready for gym class. In Kentucky, elementary schools must offer some type of physical activity for 30 minutes each day, but that can include unsupervised recess. There are no physical education requirements in middle schools, and high-school students just need to take one half-credit of phys-ed to graduate. The decline in phys-ed is coupled with the fact that kids lead an increasingly sedentary lifestyle. In Kentucky, nearly one in three high school students watch three or more hours of TV each day and more than 60 percent of kids have a TV in their bedroom.

A lack of play time after school is another culprit, in large part because "There's a lot of media that say it's not safe to go outside and play," Russell said. In fact, just over 100 children are kidnapped in a stereotypical way each year in the U.S., according to the National Center for Missing & Exploited Children, and the number of violent crimes was lower last year than it has been in 40 years. Yet, fear of the unknown is embedded in parents, Gray said, who sees parents waiting in their running cars for their children to be dropped off at bus stops. "What a huge impact changing that attitude would make," she said.

(Photo by Tara Kaprowy, Kentucky Health News)

While the report "Shaping Kentucky's Future: A Community Guide to Reducing Obesity" estimates 33 percent of Kentucky children are already overweight or obese, there is no way of knowing how those numbers vary county to county, because there is no systematic collection of them. Body-mass index, a rough measure of fat to weight, is measured statewide only for children aged 2 to 4 in the Women, Infants and Children nutrition program. "Some individual school districts and counties are collecting more information, but it is spotty," said Sarah Walsh, senior program officer at the Foundation for a Healthy Kentucky.

Starting this school year, the state board of education started requiring that there be a place on the state health exam form that includes a student's BMI, though physicians are not required to fill it in. The exams are required when a student enters school in Kentucky, generally in kindergarten, and again when a student is about to enter the sixth grade. "I would say it's a start but this is not a mandate on students or parents or physicians or schools. This is an option," said Lisa Gross, spokeswoman for the Kentucky Department of Education. Still, the BMI information could be shared at the aggregate level if the Department of Public Health asked for it as part of an analysis, Gross said.

But regardless of what data is collected, there is a problem "showing us basically whatever age group you look at, you've got too high of a proportion of children who are overweight and obese," said Amy Swann, senior policy analyst for Kentucky Youth Advocates. Some data show obesity rates are higher in children living in the Appalachian part of the state. Many studies also correlate children from low-income families with higher obesity rates. Giving counties an idea of where they stand is essential to getting a handle on the fight. "There is an old adage that 'what gets measured gets done,' and it couldn't be more true in this case," said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky. "Local communities need to know where they stand on this important health issue so they can track progress and really make changes with childhood obesity."

NEXT: What is being done in nationwide, in Kentucky, and in individual communities to address the problem.Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Students in Kenton County Schools sample kale chipsas part of an effort to incorporate more fruit andvegetables into their diets. (School district photo)

By Tara Kaprowy
Kentucky Health News

Now that all schools are back in session, cafeterias in every corner of Kentucky are bustling with students sweeping through lunch lines, sitting down with their best friends and sampling their meal.

It's in these loud, boisterous rooms that the fight against childhood obesity, which is higher in Kentucky than in all but a few states, is beginning to take shape.

Many children eat more than half their calories at school, but schools are just one of the battlegrounds. Across the country and the state, there are initiatives that are gaining traction to take a bite out of the problem.

When school started this year, the 556,000 Kentucky kids who get their lunch from school cafeterias may have noticed a more apples and oranges on their plates. With the goal of creating a healthier school environment, the United States Department of Agriculture has revamped school lunch regulations for the first time in 15 years. Many of the changes involve what some see as the saviors of kids caught in the obesity epidemic: fruit and vegetables.

In order for lunches to qualify for School Lunch Program funding, students now must have at least one serving of fruit or vegetables on their plate by the time they reach the cash register. And "vegetable" no longer just means French fries. And at least once each week, schools must serve a green, leafy vegetable like broccoli or spinach, plus an orange or red vegetable like carrots, and a legume like lentils or chickpeas, which are a good blend of protein and carbohydrates with very little fat.

Food service directors are optimistic elementary studentswill adjust to school lunch changes, but high schoolersare a different story. (Kenton County Schools photo)

Will students actually eat those foods? Julia Bauscher, food service director at Jefferson County Public Schools, is optimistic about elementary school students. So is Ginger Gray, director of food services in Kenton County, who has been serving such vegetable dishes as broccoli parmesan and kale chips for several years.

"Kids are more open to trying new things than adults realize." Gray said, but "It takes persistence. You can't just say I tried it once and kids didn't eat it so you don't try it again."

High school students are a harder sell. Sylvia Moore, child nutrition and food service director at Mercer County Schools, said lunch participation rates have dropped by about 5 percent since the beginning of the school year. "Just this week I was up at the high school to stand at the garbage can. I was just there a minute when a girl came and tossed her totally-untouched orange in front of me," she said. "We are already making healthier garbage cans," not healthier students, she added.

The media angle

Another nationwide effort involves what children see on TV, which could have a big impact. A 2009 study found they average more than 32 hours a week. Excessive TV viewing is linked to a sedentary lifestyle, and American children see about $1.6 billion a year worth of food and beverage marketing. "It's a double-whammy," said Josh Golin, associate director for the Campaign for Commercial-Free Childhood. "It's the combination of not moving, and being urged to consume unhealthy food."

(Kentucky Health News photo)

By 2015, that will change on channels of the Walt Disney Co., which will no longer put ads for products like Capri Sun and Kraft Lunchables (left), as well as a variety of candy, sugared cereal and fast food.

The television show iCarly, popular on Nickelodeon, is approaching the issue differently, encouraging viewers to create their own wacky veggie dish and submit the recipe for the "iCarly iCook with BirdsEye" intiative. Spots on the channel show the kinds of dishes the contest wants, like a "veggie sundae," which consists of a scoop of carrots, cauliflower and broccoli in a banana split dish.

A 2006 study showed 88 percent of the food ads on Nickeldeon promoted unhealthy food. A year later the channel announced its characters like Dora the Explorer and SpongeBob SquarePants would be licensed to sell only healthy foods; that's why Dora appears on packages of frozen edamame -- green soybeans, often in their pods.

Teaching the basics, and behaviors

Statewide programs are also infiltrating directly into communities. One involves cooking classes, with teachers from the University of Kentucky's Nutrition Education Program setting up demonstrations everywhere from public housing to women's crisis centers to church basements.

For 10 weeks, the teachers educate low-income adults about the basics of cooking with the hope they will change the way they feed their families. "We talk to them about how to use coupons, how to use dried beans instead of canned beans, how to use those leftovers and how to stretch their food dollars so they can provide good-tasting and nutritious food," said Debra Cotterill, the program's director.

The 43-year-old program was created to teach people how to use government commodities, like big blocks of cheese, that they received in the 1970s. Since obesity has become so prevalent, Cotterill said the emphasis has changed and interest in classes is up dramatically. In fact, Cotterill said the extension program's whole mission has expanded.

"It is not enough to share information, we also have a responsibility to help change behaviors," she said. "Now, all agents do some type of nutrition education in their work somewhere or other, even the ag agents, because it's become such a problem in our counties."

State regulations lack some specificity

Since many children entering kindergarten are already overweight, state government is examining preschools and daycare centers to see what policies they have in place when it comes to nutrition and physical activity. Though there are state regulations for licensed child care centers, "the language is not specific," explained Elaine Russell, the state's obesity prevention coordinator. For example, regulations say bread should be served with meals, but don't specify the type of bread, such as whole grain or whole wheat, and don't prohibit high-fat snacks or sugar-sweetened beverages.

As part of a pilot program, state workers went to nine facilities each in Northern Kentucky, the lower Green River region and the Barren River region to assess their policies, teach directors and staff about obesity in Kentucky and discuss goals with directors and staff about their goals.

They also taught them the program 5-2-1-0, a catchy way of reminding students they should have five servings of vegetables each day, no more than two hours of screen time, at least one hour of physical activity and drink zero sugary beverages. The program is being pushed by pediatricians and at offices where poor mothers sign up for the Women, Infants and Children nutrition program. "Our goal is to make sure our parents hear this from more than one spot," Russell said. "We can change these policies but unless parents understand why we're making them, they probably won't stick."

Many facilities in the pilot program didn't have wellness policies before the process, but all did afterward. However, Russell would also like to see child-care centers adopt the standards for nutrition and physical activity as suggested in Caring for Our Children: National Health and Safety Performance Standards, which have stronger guidelines that promote active play every day and follow minimum standards as recommended by the USDA's Child and Adult Care Food Program. "Some states require at least two hours of physical activity a day, she said. "Physical activity is encouraged in Kentucky, but it's not specified. Kentucky rules do limit screen time, but kids are still allowed to watch two hours a day."

An early start

Some programs focus on even younger children, including infants, and pregnant women. "A lot of times when we talk about childhood obesity, we kind of default into talking about school-age kids," said Amy Swann, senior policy analyst for Kentucky Youth Advocates. "But if we're going to take a really multi-faceted approach, what we now know is it actually starts with the mother's nutrition while she's pregnant."

(University of Louisville Hospital photo)

That idea is behind the Kangaroo Care Initiative, which promotes skin-to-skin contact with new mothers and their babies in order to promote breastfeeding and bonding. Among other benefits, breastfeeding can help reduce the risk of obesity. One study showed children who were breastfed were 22 percent less likely to be overweight by age 14, said Marlene Goodlett, Kentucky's breastfeeding coordinator.

The effort started in 2007 with the University of Louisville's Hospital Center for Women and Infants. This year, U of L partnered with the WIC program to train all 51 birthing hospitals in the state. Now, 84 percent of them have implemented Kangaroo Care. One of the first hospitals on board was Flaget Memorial Hospital in Bardstown, where breastfeeding rates increased to 61 percent from 49 percent.

Community lessons

From a walking trail mowed on land owned by the community hospital in Winchester, to the Hopkinsville farmers' market accepting food stamps, there are local efforts to combat obesity in place that, inch by inch, are causing change.

One of these is the Better Bites program in Lexington, a revamp of how food is sold at swimming-pool concession stands in Lexington. "We learned you could exercise at the pool for two hours, go to the concession and get a standard hamburger, fries and soft drink combo and you would actually take in more calories that you're burning. That was a shocking statistic for us and really propelled us along," said Brian Rogers, deputy director of enterprise at Lexington Parks and Recreation. Organizers introduced menu items like yogurt and fresh fruit, replaced hot dogs with turkey dogs, standard popcorn with low-fat popcorn and sold only baked chips at two public swimming pools in the city starting last year. This summer, candy sales went down 20 percent. and the Better Bites menu items constituted 15 to 20 percent of all sales, up from 10 percent last summer, Rogers said.

Berea is concentrating its efforts on environmental change with its Complete Streets project, which is aimed at making the city's streets more accessible to walking and biking. Two major projects — a bridge project that includes sidewalks and bike lanes and a three-mile trail that connects downtown with the Indian Fort Theatre — are opening up much more territory to pedestrians. The city has coupled these efforts with simple changes like making walkways more visible, installing bike racks around town, and changing the timing on lights to give pedestrians more time to cross the road.

Mayor Steve Connelly said the effort is about culture change. "I do think that we have perhaps by accident created these barriers to walk and bike largely since the 1950s when America really fell in love with the Interstate, franchise restaurants, the suburbs and the automobile," he said. "Really, we need to get back to walking as second nature." With each installation of more sidewalks and trails, though, that is exactly what is happening, Connelly said. "It's the classic when you build it, they're out there using them," he said.

Still a way to go

While progress is being made, experts say the nation is just beginning to round the corner on the problem. Though some studies show childhood obesity and overweight rates may be leveling off, many kids are simply graduating from the overweight to the even more unhealthy obese category, said Dr. Christopher Bolling, a Kenton County pediatrician.

After a visit this fall to school cafeterias to document changes that are happening there, perhaps reporter Lenny Bernstein said it best in The Washington Post: "If we don't yet know how well we're doing in this battle, we are at least figuring out how to develop our weapons."

NEXT: Why the obesity epidemic is such a difficult problem to solve.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Nearly every weekday, pediatrician Christopher Bolling starts his day by scooping up his lap top and stepping into one of his cheerfully-appointed exam rooms. After greeting his young patients, who are generally passing the time by playing games on their parents' cell phones, Bolling begins his examinations. During his 21 years of practice, those exams have increasingly ended with Bolling counseling parents about their children's weight.

"I tell them I'm not worried about this as a cosmetic issue, I'm worried about this as a health issue," he said in an interview. "This isn't about your child being ugly or undesirable, we talk about them being healthy and not healthy."

But, though dedicated to his cause, Bolling, of Crestview Hills in Kenton County, said he is keenly aware that his counseling is not nearly enough to help his patients overcome the weight that is impeding their health. "What makes this problem unique is it is so multifactorial, there are so many pieces to it," he said. "It's food, it's activity, it's portion size, it's fruit and vegetables, it's screen time and safety. And it makes it really intimidating to know what to do with it."

"We're swimming upstream in a flooded river," agreed Debra Cotterill, director of the Nutrition Education Program at the University of Kentucky. "Even for people who know it, it's still hard. Weight is an issue I have to address every single day of my life and I understand how it is for people. You're talking about change of behaviors."

It's like smoking, but it's different

But a sweeping change in behavior is going to be what it takes to turn the tide of the obesity epidemic, experts say, and that is one reason fighting obesity is often likened to the battle against smoking. The fact that it is just as, if not more, deadly is another parallel, as is the fact that it is just as, if not more, far-reaching.

But there are key differences in battling the two problems, Judith Graham noted in a story for Kaiser Health News. First, other than an increase in health-care costs, there is no compelling argument that implies that another person's weight adversely affects others, like second-hand smoking does for smoking, or drunk driving does for drinking to excess. "The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people's intolerance of smoking and their willingness to see the government take action," Michael Ericksen, director of the Institute of Public Health at Georgia State University, told Graham.

Compounding the issue is there is nearly no end to the variety of food that can contribute to the problem. Unlike Big Tobacco, the food industry also cannot be demonized as easily, Graham points out. But most importantly, "unlike alcohol and tobacco, you can't go cold turkey on food," Bolling said. "You have to keep eating."

But if there is consensus on how to approach the issue, it is to take a lesson from the battle against smoking, which is to focus on changing the environment that encourages bad habits. "It's about changing our culture," explained Elaine Russell, Kentucky's obesity prevention coordinator. "We need an environment where the healthy choice is the easy choice."

That involves policy change, setting up systems that support the policy changes, and environmental change, Russell said, all of which have to happen together. "There's no one solution that's going to do it," she said. "If we embed it in our policies, but we don't embed it into our environment, how do we make the healthier choice? If we just educate people but we don't provide them with a healthy environment, then how do they make those healthy choices? We could do an educational campaign at our worksite, but if we have unhealthy vending machines there, how can you make the changes?"

Local action is needed

Russell said change needs to happen at the local level, since every community has different needs and "starts with high-level partners really being engaged," she said. "We need to pull together those leaders and ask them what the highest priority is, ask them what feasibly can be done and start checking them off."

Some of those changes can be as easy as placing bananas and apples at the front of the pool concession stand so children see them first, as they did in Lexington. The same is being done in school cafeteria lines. But others cost money that communities don't necessarily have, as the Healthy Children's Task Force learned in Laurel County when trying to assess students' body-mass index, a rough measure of fat to weight.

In 2005, the task force started collecting BMIs of a select group of children in kindergarten to see where the county stood. It found 37 percent were either overweight or obese, and quickly decided the goal should be to bring that number down to 31 percent, the statewide average at the time. Using a grant from the parent company of the local hospital, they talked to parents, hired gym teachers, had schools incorporate 10 minutes of physical activity in the classroom periodically during the day, talked to kids about nutrition, and got them to cook and sample fruit and vegetables from a mobile demonstration kitchen.

The overweight rates of the children, who were repeatedly assessed each year, did decrease by the targeted 6 percent, but when funding ran out, the program faltered. For a few years, part of the effort was restored, but the task force has disbanded. "You get real gung-ho on it and something else comes along," said school nurse Duff Holcomb, who led the effort. "It makes me feel terribly guilty, but that is just the way it is. We proved what works."

After a recent analysis showed 12 states, including Kentucky, have adult obesity levels over 30 percent, Jeffrey Levi, executive director of Trust for America's Health, acknowledged the financial problem: "We're not investing anywhere near what we need to in order to bend the obesity curve and see the returns in health and savings."

(Photos by Tara Kaprowy)

More regulation is one option, a move that is generally cheap in cost but can be politically expensive. New York City Mayor Michael Bloomberg is learning that, after proposing a ban in New York City on the sale of supersize sodas and other sugary drinks by restaurants, movie theaters and street carts. Residents are deeply divided on the issue — 60 percent oppose the ban — and critics have lambasted Bloomberg, accusing him of running a "nanny state."

But limiting food and drink choices may have an effect on people's health, a recent study indicates. The removal of trans fats from many processed and fast foods like French fries and cookies probably reduced the proportion of kids with high cholesterol in the past decade, researchers think.

More regulation, particularly in how food is marketed to children, is what Josh Golin, associate director for the Campaign for Commercial-Free Childhood, would like to see. "We can't rely on the companies to self-regulate or develop their own policies," he said. "We see a lot of self-serving regulations that vary from company to company. What we really need is to level the playing field and make the rules enforceable."

In addition, Bolling suggested "there are several organizations that advocate that we could make a big impact on childhood obesity by placing an excise tax on sodas." A report by the Rudd Center for Food Policy and Obesity at Yale University indicated that a 10 percent tax on soft drinks would result in about an 8 percent reduction in consumption. Studies on alcohol and tobacco taxes indicate similar findings. A Rudd Center calculator shows a 1-cent tax on each ounce of sugar-sweetened beverages sold in Kentucky could result in nearly $200 million in revenue for the state.

Whether regulation or investing more money in the problem are part of the solution, Bolling said solving the problem will take time and a variety of efforts. "We have to solve everything together," he said. "It's about personal responsibility, but it's also about supportive families, it's about primary care medical people knowing what to say to their patients, it's about workplaces and schools creating good environments and it's communities providing opportunities to be healthy. I think we're going to turn the tide. We've done it before with seat belts, with bicycle helmets, with smoking. While this problem is complicated, we already see people really waking up to it."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

The U.S. Census Bureau released data this week showing 2010 estimates of health insurance coverage for all 50 states and each of the nation’s counties. The data are exactly what journalists need to do their own stories about the problem of the uninsured and the potential impact of Medicaid expansion under federal health reform.
Laura Ungar of The Courier-Journal in Louisville used the data to show what parts of Kentucky have the most uninsured and which would benefit most from Medicaid expansion.

The census report "looked at how many of the uninsured fall into an income category that would make them eligible for Medicaid under the Affordable Care Act -- which would be expanded to cover those who earn up to 138 percent of the federal poverty level ($15,415 for one person and $31,809 for a family of four)," Ungar reports.

"The U.S. Supreme Court’s June ruling upholding the health care law forbade the federal government from withholding current Medicaid funds from states that refuse to expand the program in 2014 -- and Kentucky and Indiana leaders haven’t yet decided whether to opt in or out," writes Ungar.

The greatest area of need in Kentucky was in the state's south-central region which is part of Appalachia but has no coal. Ronald Wright, judge-executive in Casey County, told Ungar that his hilly county depends largely on industries such as timbering and farming, and many residents don’t have employer-sponsored health coverage. “I don’t know how we correct it,” Wright said. “Most people just can’t afford (insurance.) It’s getting so expensive.” He said the uninsured often seek care in emergency rooms that can’t turn them away or at the local health department, which “is always busy.”

Michael Price, Kentucky state demographer, said the state’s poorest counties, generally in the Appalachian region, don’t usually have the highest rates of uninsured residents. “In the poorest areas of Kentucky, there’s a fair amount of participation in federal programs, so they’re covered,” Price said. “It’s the marginal folks who aren’t qualifying for federal programs who are falling through the cracks.”

The web page with Ungar's story has a list of Kentucky counties and the number of uninsured. To read it, click here. The Census Bureau press release has a link to a list of every U.S. county with estimates of the number of people who would be covered if Medicaid were expanded to 138 percent of the poverty level.

Thursday, August 30, 2012

With school back in session, it probably won't be long before children are coming home with sniffles and sore throats. The average child gets six or more infections each year, reports Dr. Jacqueline Kaari, chair of the Department of Pediatrics at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, who also offers advice.

"Every parent has experienced it — the hectic morning maneuvering of getting the household fed, dressed and out the door is suddenly interrupted by an inconsolable child who has a sore throat, upset stomach, sniffles or something worse," she said. "When that happens, parents need to be able to quickly assess their child and determine if he or she is well enough to go to school or needs to stay home, or if it's time to call the pediatrician. Sometimes, parents will guess wrong, but if there's one rule of thumb, it should be to always err on the side of caution."

Kaari recommends the following guidelines for what do when it comes to:

Colds: Use child-strength, over-the-counter medicines and a cool mist humidifier to treat symptoms. Because they are caused by viruses, do not treat colds with antibiotics. Children can go to school if the symptoms won't impede them from participating in school activities.

Conjunctivitis (pinkeye): Go to the doctor for treatment, which is generally antibiotic eye drops. Children can usually go to school 24 to 48 hours after treatment starts.

Fever: Give acetaminophen (Tylenol) or ibuprofen (Advil) for low-grade fevers. Have the child drink lots of fluids and avoid fatty or fried foods, since fevers decrease stomach activity and make digestion more difficult. Keep children at home if the fever is above 100.4 degrees Fahrenheit. Call the doctor if a high fever lasts more than 24 hours or does not respond to medicine.

Flu: Have the child vaccinated. If he or she has not been vaccinated, keep the child home for several days and make sure he or she gets lots of rest and drinks lots of fluids.

Head lice: Kill with over-the-counter or prescription lotions and shampoos. Keep the child at home until all lice have been killed.

Ringworm: Look for small patches of skin that are scaly and red. They can also blister and ooze. Apply anti-fungal ointments or powders. Call the doctor if the infection is severe or does not go away.

Sore throat: If parents suspect strep throat, they should call the doctor. If drinking water relieves symptoms somewhat, the child likely has a viral infection that should go away in a few days.

Stomach ache: Children who have been vomiting should stay home from school. An hour after the child vomits, parents should start introducing small drinks of water. Clear liquids and bland food should be introduced throughout the day. If vomiting lasts more than 24 hours or if the child vomits blood or green or yellow bile, call the doctor.

Whooping cough (pertussis): Have the child vaccinated. If parents suspect whooping cough, characterized by a "whooping" sound when the child tries to breathe, call the doctor. (Read more)

To help the increasing number of veterans and military service personnel who are needing treatment for substance abuse and mental health issues in Kentucky, a task force has been assembled to come up with strategies that show the most promise in providing care.

The team, made up of military personnel as well as health care experts, will go to a conference in Washington, D.C., to gain learn what is working elsewhere. The goal is to strengthen statewide behavioral health care systems and services, a press release from Gov. Steve Beshear's office says.

Over the past three years, the number of veterans seeking mental-health care has risen dramatically, according to the U.S. Department of Veterans Affairs. About 335,000 veterans live in Kentucky. There are also 45,000 active-duty personnel in Kentucky and about 8,400 members of the Kentucky Army National Guard and Kentucky Air National Guard.

"This is an extremely important and timely topic that requires collaboration across federal, state and local lines," said Col. David Thompson, executive director of the Kentucky Commission on Military Affairs. Task force members include Thompson; Maj. Gen. Edward W. Tonini, Kentucky adjutant general; state Rep. John Tilley, D-Hopkinsville; representatives from the Cabinet for Health and Family Services, the Kentucky Department of Veterans Affairs, military and civilian health facilities and the Kentucky court system. (Read more)

The life expectancy of the average U.S. female increased 1.7 years from 1999 to 2009 -- 79.6 to 81.3 years. Good news on the whole, but Daily Yonder reporters Bill Bishop and Robert Gallardo went a little farther in their analysis of the data from the Institute for Health Metrics and Evaluation at the University of Washington. They found that rural women hardly kept up, and some even lost ground in the decade while their urban sisters obviously gained from widespread health advances.

Bishop and Gallardo report, "The solid gain in longevity was matched in only 168 rural or exurban counties, or 6.5 percent of all the counties outside the cities." That is, while women in most of the nation were living longer lives, in many rural counties -- some 622 of them, in fact -- their longevity shortened in the same decade. Several of those counties were in Eastern Kentucky. The 622 counties represent some 24 percent of rural counties and exurban counties (or counties in a metro area where more than half live in rural census tracts), women lived shorter lives in 2009 than in 1999. You can see a similar map and charts for rural men here. (Click on the above map for a larger image)

As the Yonder writers point out, "The map shows that rural and exurban women are not keeping up with the health advances enjoyed in the rest of the country. In more than 95 percent of rural and exurban counties, changes in female longevity in the last 10 years failed to match the gains experienced in the rest of the country." The largest decreases in female life expectancy between 1999 and 2009 were clustered in Oklahoma, Eastern Kentucky, West Virginia, Alabama and Georgia. (Read more)

Tuesday, August 28, 2012

Christian County's health director told the county Board of Health last week that it "needs to spend less time on the health department’s budget and more time addressing big questions of community health," Nick Tabor writes for the Kentucky New Era. "The past four years, we haven’t talked about a lot of health issues. That’s going to change,” Director Mark Pyle told the 12-member board, which is appointed by the state secretary of health and family services.

Other county health boards may be hearing likewise, as their departments seek national accreditation (required by 2020, under a recent state law) and more attention is focused on the boards' stautory responsibility for the health of their communities. (Photo from the Knox County Health Department, which had a cake to celebrate the recent opening of its new building)

Accreditation steers health departments away from a “silo” model in which they worry only about its own affairs, Assistant Christian County Health Director Laura Hammons said. Pyle said their department needs to help build a “community health system” involving all all local organizations involved in health matters, from the Red Cross to the YMCA. (Read more)

County health boards should "assume responsibility for educating their population about improving their health status," be "highly visible and proactive," and play a leading role "in developing healthy community coalitions and partnerships," the statewide Friedell Committee for Health System Transformation said in a report, "The Role of Public Health and the Health of the Community," published in May.

Partly as a result of the committee study that led to the report, "Actions have been taken to increase training for local boards of health, including presentations by the commissioner of public health at board meetings and several training sessions at the state level for board members," the report said.

The report notes that KRS 212.240 requires county health departments, under supervision of county health boards and the state, "formulate, promote, establish, and execute policies, plans, and programs to safeguard the health of the people of the county and establish, maintain, implement, promote, and conduct facilities and services for the purpose of protecting the public health." To download a PDF of the report, click here.

County health board members include three physicians, a dentist, a nurse, a sanitary engineer, an optometrist, a veterinarian, a pharmacist, a lay person "knowledgeable in consumer affairs," the county judge-executive and a person appointed by the county fiscal court. If a county lacks one of the categories, another consumer representative can be appointed. For a PDF of the law, click here. For an index of all the laws on county health programs, click here.

Floyd and other workers have put on the costume, as well as others depicting corn, grapes, carrot and watermelon, to encourage kids to eat more healthy, reports Robert Nolin for the Fort Lauderdale Sun Sentinel. "We're trying to attract attention to the concept that fruits and vegetables are good for you. They're good to eat, they're fun," said Darlene Moppert, a nutritionist who helps feed about 140,000 students each day.

Moppert said kids need to be prodded to eat healthily because "their consumption of fruits and vegetables is not where it needs to be." In addition to the costumes, Moppert hosts focus groups to see what students like to eat; do "plate waste" studies; and buy fresh produce from Florida farmers. She also working with popular menu items like pizza, burgers and chicken nuggets to make them more healthy. "We're taking what kids like and are familiar with and making it in a form that's a little healthier," she said. (Read more)

Because they use extracorporeal (out-of-body) membrane oxygenation, or ECMO, to support patients, the University of Kentucky's Albert B. Chandler Hospital and Kentucky Children's Hospital have been awarded a triple designation from the Extracorporeal Life Support Organization. UK is just the fifth medical center to receive the triple-designation honor, reports UK's Allison Perry. (UK photo)

ECMO uses an artificial lung device that gives "cardiac and respiratory support to patients whose heart and lungs are so severely damaged that they can no longer function," Perry reports. "It can also serve as a bridge to transplantation, allowing patients to not only survive, but to become stronger and healthy enough to undergo the transplant surgery." The technique is used on neonatal, pediatric and adult patients, hence the triple designation.

"This designation is another example of the expertise and advanced technology available for neonatal to adult patients who require complex care that can only be provided at top academic medical institutions," said Dr. Michael Karpf, UK's vice president for health affairs. (Read more)

Monday, August 27, 2012

Tobacco use is higher among rural communities than in suburban and urban areas, and smokeless tobacco use is twice as common. According to the American Lung Association, rural youth are more likely to use tobacco and to start earlier than urban youth, perpetuating the cycle of tobacco addiction, death and disease.

In its latest health disparity report, “Cutting Tobacco’s Rural Roots: Tobacco Use in Rural Communities,” ALA says the increased tobacco use is associated with lower education levels and lower incomes, which are both common in rural areas where there may be fewer opportunities for educational and economic advancement.

The exposure to secondhand smoke is also likely to be higher, since rural communities are less likely to have smoke-free air laws in place, and that probably makes residents less likely to ask individuals not to smoke in their homes or other indoor places they control.

The report also pointed out that the tobacco industry "spends millions of dollars targeting rural youth," and "these young people are less likely to be exposed to tobacco counter-marketing campaigns. Rural tobacco users are also less likely to have access to tobacco-cessation programs and services to get the help they need to quit. Promotion of the availability of state counseling services by phone and online resources also lags in rural communities."

The Appalachian News-Express, the thrice-weekly newspaper in Pikeville, has turned the spotlight on Pike County physicians and pharmacists who are aiding and abetting the abuse of prescription painkillers. We have to wonder if more reporting like this from local news media wouldn't help fight the problem, which has become epidemic in Kentucky, especially in the east.

"Prescription drug abuse has dominated news headlines across the state
over the last several weeks and new cases are leading officials to
believe that more and more cases will be filed against physicians in and
around Eastern Kentucky," the 2,200-word story begins. "Officials on both the state and federal level
have been busy over the last year in taking action against a number of
medical professionals, both in and around Pike County."

The full story by Chris Anderson is available only to subscribers, but is available to members of the Kentucky Press Association who subscribe to its Kentucky Press News Service.

Sunday, August 26, 2012

The Courier-Journal's health reporter, Laura Ungar, is again delving into the prescription pain-pill epidemic in Kentucky, this time focusing on babies who are born addicted. For any reporter interested in writing stories about prescription pill addiction and the scope of the problem — stories that could be localized in every county in the state — Ungar's award-winning work is the place to start researching.

There are also links to more recent stories pertaining to the issue here.

Ungar found hospitalizations for addicted newborns increased from 29 in 2000 to 730 last year, when there was a big jump. "It's a silent epidemic that's going on out there," said Audrey Tayse Haynes, secretary of the state Cabinet for Health and Family Services. "You need to say: 'Stop the madness. This is too much.'"

Nurse Tonya Anderson, an infant development/touch therapist at Kosair Children's Hospital, said she's seen as many as 14 of 26 babies in the special-care nursery where she works suffer from symptoms of withdrawal. "They are just agitated," she said. "They are screaming. They have tremors. Their faces — you have to grimace. They're in pain."

Those close to the problem say there is not enough treatment for addicts who are pregnant. But it's an investment worth making, Ungar suggests. One study showed the health-care costs for addicted newborns was $720 million in 2009, up from $190 million in 2000. Babies with addictions stay about 16.4 days in the hospital, which costs an average of $53,300 per infant. In 80 percent of those cases, Medicaid pays the bill.

Researchers estimate that more than 13,5000 babies were born addicted in 2009. "We knew that it was common, but we would not expect this problem would have tripled in the last decade," said Dr. Matthew Davis, an associate professor at the University of Michigan and one of the study's authors. "There are not many medical problems that have tripled in a decade — not obesity, not heart disease, not diabetes." (Read more)

Saturday, August 25, 2012

One of the most complex and far-reaching pieces of
legislation to pass in recent years is the Patient Protection and Affordable Care Act, the federal
health-care reform law that, among other provisions, requires Americans to buy
health insurance or pay a penalty.

But because of its complexity, journalists can shy away from delving into stories about it. With state insurance exchanges and Medicaid expansion sure to be hot topics during the election season and the legislative session, it’s important to have reliable sources of information about the law. The American Public Health Association has a website that answers many if not most of the questions
reporters, and the public, often have.

The website:
• Reviews the fundamentals about the Affordable Care Act and
links to information about Medicaid expansion, insurance exchanges and the
individual mandate.

• Looks at the implementation timeline of the law.

• Includes fact sheets about the ACA’s prevention funding
program, which allows seniors and others to get free preventive care including
mammograms and other screenings.

• Breaks down the U.S. Supreme Court’s decision to uphold
the law.

The website is a useful tool in any health reporter’s
arsenal and is worth a look. (Read more)

More than 40 percent of the time, Americans are turning to
higher-paid specialists instead of primary-care doctors to deal with their basic health needs, including colds and fever, a new study has found.

Researchers at Mount Sinai Hospital in New York looked at data from more than
20,000 doctor visits in 1999 and 2007 that included information about why the
patient had come to the doctor’s office. “Fifty-nine percent of those with
primary care needs, the runny-nose group, were seen by a primary care doctor,”
reports Sarah Kliff for The Washington
Post. “Forty-one percent sought out care at a specialist.”

Researchers included gynecologists and internal medicine
physicians in the specialists group, though they tend to have heavy primary
care loads. But even without those two specialties, 27 percent of primary care
appointments happened in specialists’ offices.

A 2010 study found primary care doctors earn a $69 hourly
rate, compared to $92 per hour and $85 per hour that surgeons and ob-gyns earn, respectively. (Read more)

Dr. Tara Palmore, deputy hospital epidemiologist at theNational Institutes of Health Clinic Center, left, and Dr.Julie Segre, a geneticist with the National HumanGenome Research Institute. Both were integral inpinpointing the spread of a superbug at NIH.Associated Press photo by Patrick Semansky.

A candid account of how a superbug was contained at one of
the nation's leading research hospitals indicates that fast sequencing of a germ’s
full DNA can make all the difference.

Over a six-month period, Klebsiella pneumonia, or KPC, a germ that
cannot be treated by most antibiotics, sickened 18 people at the National Institutes of Health. Six of
them died and another five, though they survived the effects of the germ, died
from the disease that originally brought them to the facility.

Infections at health-care facilities kill about 100,000 Americans each year. But, fearful of lawsuits, hospitals generally
don’t reveal to the public when infections outfox control measures, reports
Lauran Neergaard for The Associated
Press. That changed this week when government researchers published the story of what happened at NIH.

Dr. Julie Segre, a senior investigator at NIH’s National
Human Genome Research Institute, was in charge of the “genetic sleuthing that
found the bug hiding in sink drains and, most chilling, even in a ventilator
that had been cleaned with bleach,” Neergaard reports. A multidrug-resistant strain of Klepsiella bacteria has emerged that spreads easily
between patients who are very ill, and it kills half of whomever it sickens.

On June 13, 2011, a research nurse checked the medical
records of a study participant who was being transferred from a New York City
hospital and was critically ill with a rare lung disease. She found the patient
had KPC, prompting the hospital to put her in strict isolation. “Everyone
entering her room donned a protective gown and gloves and rigorously washed
their hands,” Neergaard reports. “Her medical equipment got special
decontamination. All other patients in the intensive care unit had their throats and groins
tested regularly to see if the bug was spreading.” All seemed to be clear and
the woman was sent home two days later.

But three weeks later, a patient with cancer was found to
have KPC, though he was never in the presence of the first patient. Ten
days later, a woman with an immune disease also got sick with KPC. Both died from
the infection.

Researchers wondered if the cases were related or if the
patients were arriving already infected with KPC. Segre turned to DNA for answers. "As
bacteria multiply, mistakes appear and are repaired in their genetic codes," Neergaard reports. "Sequencing that genome allowed Segre to follow differences
in single genetic letters like a trail of the germ’s transmission and
evolution." Using this method, Segre discovered the KPC appearing at NIH was
the same strain that came from the New York patient. "Testing bacteria from the
17 additional patients who ultimately caught it shows the KPC was transmitted
three separate times from Patient No. 1 and then spread more widely," Neergaard
reports.

NIH completely overhauled its decontamination practices,
but the bacteria continued to spread. By November, the bacteria appeared in two patients who were not even in intensive care. Finally, the hospital built a new
isolation room and all 200-plus patients in the hospital were subject to rectal
testing.

The contamination is now contained, but the account of it is giving pause to infection-control specialists around the country.
“Absolutely this could happen in any hospital,” said Dr. Deverick Anderson,
co-director of a Duke University
infection control network. (Read more)

Friday, August 24, 2012

The effort to pass a smoking ban in the largest Kentucky town without one may have hit a roadblock Thursday night. The Hopkinsville City Council forwarded a smoking ordinance that would merely require businesses to decide whether to allow smoking and post signs at every entrance announcing its policy. The council's vote as a committee of the whole was 6-5, and the one absent council member favors a typical smoking ban.

Mayor Dan Kemp, who can vote to break council ties and does not sit on the committee of the whole, "said after the meeting that he could not support the proposal because it leaves the current law unchanged," Carla Jimenez reports for the Kentucky New Era. The alternative ordinance is scheduled for first reading Sept. 18; a tie vote would block it, and a tie vote in favor of a smoking ban could be broken by Kemp to pass it.

As first presented to the committee, the ordinance would ban smoking in public places, with exemptions for private clubs,
age-restricted establishments and businesses with 12 employees or fewer. The small-business exemption was removed on a vote of 10-1. "That left the ordinance as it originally came before the council for its first reading in June," Jimenez reports. But then the committee voted 6-5 for the alternative ordinance, proposed by Councilman Paul Henson, who argued, “We’re not abusing anybody’s rights. We’re not the bad guy, and yet we
have the smoking ban, a smoking ordinance, on the books.”

Councilwoman Peggy Rogers-Everett disagreed, saying smoking is a hazard to everyone, and “Murder is illegal.” Henson and Councilwoman Ann Cherry and Henson laughed, and "Everett was not amused," Jimenez reports. Everett said, “I don’t find that funny. I don’t take that lightly.” (Read more)

Russell County Hospital in Russell Springs will be managed by Lexington's Central Baptist Hospital, at least for the next three years. The deal announced this week is the latest in a growing consolidation of rural hospitals with larger, urban facilities, expected to accelerate under federalhealth reform.

"The three-year agreement creates an opportunity to provide greater
accessibility to a wider range of health services in Russell County,
while exploring ways to reduce costs and maintain affordability of
services," the hospitals said in a press release. "The management agreement will allow creation of a broader
continuum of care, including enhanced alignment of physicians and
hospital services."

Russell County Hospital has 25 beds and 170 employees. It is a critical-access hospital, meaning it limits admissions and patient stays in return for slightly higher reimbursements from Medicare and Medicaid. Chris McQueary, chairman of the hospital's board, said in the press release, “This strategic partnership will allow us to work more
closely with a leading health care system to provide high levels of care
in the most cost-effective way.”

Central Baptist named Robert Ramey the CEO of Russell County Hospital. He has worked at Central Baptist for 17 years, most recently as administrator of Baptist-Physicians’ Surgery Center, the release said.

A Laurel County man has shared his story after contracting the West Nile Virus, which, though rare in Kentucky, has been more common nationwide this year than it has been since it was first discovered in 1999.

Kelly Curens spent three weeks at the University of Kentucky medical center, much of which was spent in an induced coma. He started feeling sick after a camping trip at Lake Cumberland, reports Phil Penderton for WKYT-TV. The illness started with a headache and graduated to feeling dizzy, which were symptoms to similar to ones he experienced a few years ago when he was diagnosed with a brain tumor. When he went to the emergency room at St. Joseph London hospital, he had a seizure.

Curens was one of the first in Kentucky to be positively diagnosed with the virus, which has affected more than 1,100 people nationwide this year. About half of the cases have been in Texas. Four horses have been diagnosed with the disease in Kentucky since Aug. 2. Craig Carter, director of the UK Veterminary Diagnostic Lab, said Kentucky is "still in the high-risk part of the season for West Nile infection."

Curens has been treated and is feeling much better now. "From what I was told, I'm very lucky," he said. "My blood sugar and blood pressure has always been good. Had I not been healthy I probably wouldn't be here today."

The elderly, infants and babies at the most risk, said Marion Pennington, regional epidemiologist at the Cumberland Valley District Health Department.

To protect oneself from the West Nile Virus, officials advise to:
• Dispose of tin cans, plastic containers, ceramic pots and other containers that could collect water.
• Remove discarded tires from properties. They are the most common mosquito breeding grounds in the country.
• Drill holes in recycling containers.
• Drain gutters properly and clean gutters in the spring and fall.
• Turn over swimming pools and wheelbarrows when they aren't in use.
• Change the water in birdbaths on a regular basis.
• Clean and chlorinate swimming pools and hot tubs.
• Make sure screens on windows don't have holes in them.
• Wear long-sleeve shirts and long pants when outside in the early morning and late evening. (Read more)

Health officials have zeroed in on a farm in southwestern Indiana responsible for at least some of the cantaloupe that were contaminated with salmonella, an outbreak that has sickened at least 50 Kentuckians and 178 people nationwide. It has also been associated with the death of two Kentuckians.

There is disagreement between state and federal officials whether melons from the region are safe to eat, The Associated Press reports. The Food and Drug Administration says to discard any cantaloupes grown in the area that were bought on or after July 7. Amy Reel, Indiana Department of Health spokeswoman, says melons from other farms in the area are safe to eat.

The 100-acre Chamberlain Farms, 20 miles north of Evansville, seems to be at least one source of the outbreak. It stopped producing and distributing the melons Aug. 16. They sold cantaloupe to four grocery stores in Southwestern Indiana, as well as to wholesale purchasers in St. Louis; Owensboro, Ky.; Peru, Ill.; and Durant, Iowa. (Read more)

Salmonella is a bacterium that is found in the intestines of animals and is contracted from eating raw eggs or raw poultry or having those products touch other food. It can occasionally be found on produce, so the Kentucky Cabinet for Health and Family Servicesrecommends washing all fruit and vegetables thoroughly and scrubbing the rinds of cantaloupes and other melons before cutting or slicing them. As Tim Wright, the acting health director in Anderson County, toldThe Anderson News, "People use a clean knife and cut through the melon, and that can shove the salmonella right into its meat" if any remains on the rind. He recommends washing all melons in a solution of one cup of bleach to a gallon of water, because melon rinds get salmonella when rodents urinate on them.

Wednesday, August 22, 2012

Kids should brush their teeth twice a day for two whole
minutes at a time, a new public-service campaign urges. The “Kids’ Healthy Mouths” campaign includes TV spots, print ads, a website, social media messages and other
materials, reports Jennifer LaRue Huget for The Washington Post.

Campaign materials point out that “dental decay is the most
common chronic childhood disease.” More than 16 million children across the
United States suffer from it. In Kentucky, nearly 35 percent of third-grade students had untreated tooth decay, the Centers for Disease Control and Prevention's State Oral Health Profile shows.

“The mouth is the gateway to a person’s overall health, and
an unhealthy mouth can be linked to diabetes and even heart disease,” the
campaign says. “In the U.S., oral disease causes kids to miss 51
million school hours and their parents to lose 25 million work hours annually.
Additionally, oral disease disproportionately affects children from low-income
families and these children have almost twice the number of decayed teeth that
have not been treated by a dentist as compared to others in the general
population.”

The campaign includes a YouTube video channel on which there
are videos that are each 120 seconds long. The goal is for kids to watch the
videos while they’re brushing.

Research has shown brushing two minutes at a time, twice a
day, is the “optimal prevention brushing regimen,” because it “takes two minutes
for the tooth enamel to uptake the fluoride” in toothpaste, said Maria Lopez
Howell, consumer adviser for the American
Dental Association. When enamel absorbs fluoride it makes the surface
harder and more resistant to bacteria. Brushing for two minutes additionally
removes plaque on teeth. (Read more)

U.S. health officials reported Wednesday three times the usual number of West Nile cases for this time of year and one expert told the Associated Press it was “one of the largest” outbreaks since the virus appeared in this country in 1999.

So far, 1,118 illnesses have been reported, about half of them in Texas, according to the Centers for Disease Control and Prevention. Kentucky has reported few cases.

In an average year, fewer than 300 cases are reported by mid-August. There have also been 41 deaths this year. Most infections are usually reported in August and September, so it’s too early to say how bad this year will end up, CDC officials said.
AP reports that West Nile virus peaked in 2002 and 2003, when severe illnesses reached nearly 3,000 and deaths surpassed 260.

The best way to prevent West Nile disease, say experts, is to avoid mosquito bites. Insect repellents, screens on doors and windows and wearing long sleeves and pants are some of the recommended strategies. Also, empty standing water from buckets, kiddie pools and other places to discourage breeding. (Read more)

The federal health reform law continues to be a major point of contention in the presidential campaign. Yesterday, Republican vice presidential candidate Paul Ryan said, "Medicare should not be a piggybank for Obamacare," while at a rally in New Hampshire yesterday and blasted President Obama "for using $716 billion in savings from Medicare and applying it to his health care law," reports Matt Viser for The Boston Globe.

Most of that amount was taken from reductions to Medicare Advantage, a category of Medicare plans that are run by private insurance companies. The idea behind the program "was that competition among the private insurers would reduce costs," reportsPolitifact.com,a Tampa Bay Times project that fact-checks statements on public policy. "But in recent years the plans have actually cost more than traditional Medicare. So the health-care law scales back the payments to private insurers."

Ryan has proposed his own fix, a voucher program for Medicare, which Obama sharply criticized Saturday: "Now you think they'd avoid talking about Medicare, considering both of them have proposed to voucherize the Medicare system," he said. "They want seniors to get a voucher to buy their own insurance, which would force seniors to pay an additional $6,400 for their health care."

Meanwhile, the Centers for Medicare and Medicaid Services released a press release detailing how much the Patient Protection and Affordable Care Act has saved seniors. Kentucky seniors and those with disabilities have saved $78.4 million on prescription drugs since 2010. In 2012, seniors in Kentucky saved an average of $579 because of the Patient Protection and Affordable Care Act. The law covers the prescription drug coverage gap known as the "donut hole."

In the first seven months of 2012, 477,235 Kentuckians with Medicare also got at least one preventive service for free because of a provision in the law, a CMS reports.

"The health care law has saved people with Medicare over $4.1 billion on prescription drugs, and given millions access to cancer screenings, mammograms and other preventive services for free," said Kathleen Sebelius, secretary for the Department of Health and Human Services. "Medicare is stronger thanks to the health care law, saving people money and offering new benefits at no cost to seniors."

Aetna will buy Coventry Health Care for about $5.6 billion as the third-largest health insurance company poises itself for more Medicare and Medicaid patients under the federal health-care reform law.

Coventry Cares is one of four managed care organizations that supervise care for Kentucky's Medicaid patients. But since being put in place last November, the company reports it has been beleaguered by shortfalls and has threatened to end many contracts with hospitals.

"It's a deal that almost had to happen," said thomas Carroll, a Stifel Nicolaus & Co. analyst in Baltimore. "For Aetna to really compete effectively amongst the other large national managed care companies, they have to do more in terms of gaining market share in the commercial business as well as getting a bigger foothold in Medicare and Medicaid, which are the growth areas in managed care over the next decade."

The health care law "seeks to add as many as 17 million patients under Medicaid, the insurance program for the poor, while individuals states have increasingly turned to insurers to help them manage existing programs at lower costs," reports the Bloomberg News. "Medicare managed-care plans are among the fastest-growing products for health insurers as Americans age." (Read more)

Tuesday, August 21, 2012

Hundreds of tea-party activists showed up at a midday rally at the state Capitol to protest the Patient Protection and Affordable Care Act and Kentucky's involvement in its implementation. Both are issues in the Nov. 6 elections. (Photo by Pablo Alcala, Lexington Herald-Leader)

In a rare appearance at a tea-party event, U.S. Senate Republican Leader Mitch McConnell encouraging those in the crowd "to make Barack Obama a one-term president."

Sen. Rand Paul, who was elected in large measure on his tea-party identity, repeated his riposte to the 5-4 court decision upholding the law: "Just because a couple of people on the Supreme Court declares something to be 'constitutional' does not make it so," he said. "I still think the whole damn thing is unconstitutional."

Scott Wartman of The Cincinnati Enquirerestimated that 300 to 500 people attended the event, which was organized by the Louisville Tea Party. Some who attended came in support of the health care law and carried placards expressing their sentiments. "The rally also drew dozens of counter-protesters who favor Obama and the health care act," Jack Brammer reported for the Lexington Herald-Leader.

One reason for the rally was to influence legislators to fight the implementation of the state health insurance exchange that Democratic Gov. Steve Beshear has created under the law. Before the rally, the Bluegrass Institute for Public Policy Solutionsencouraged participants to ask their legislators what will happen to cost of the state-run health exchange if a huge number of Kentucky players decide not to offer health insurance to their employees.

The Bowling Green-based group also questioned the cost of expanding the Medicaid program to 138 percent the federal poverty level, which is up to individual states under the Supreme Court decision.

McConnell called the law the worst piece in modern times and the "single biggest step in the direction of Europeanizing America, because if the government ever gets its clutches on all the health care of all 306 million Americans, which it will have if Obamacare stands, the government controls the most important concern all of us in the end have — our own health and the health of our family handed over to a centralized government."

McConnell said repealing the law would be top on the agenda if Republicans win a majority of the U.S. Senate in November. But as he alluded earlier, Obama would need to be defeated to prevent a presidential veto of repeal legislation.

Debra Harper of Louisville told the Herald-Leader she suffered a mild stroke last February due to a congenital heart problem, and welcomes the law. “Our president finally gave this nation a blueprint for health care,”
she said. “It’s like a blueprint for a house. There may be some changes
you want in it, but it’s a sound structure, and people who want to
discard all of it are being cruel.”

Kentucky Health News is a service of the University of Kentucky's Institute for Rural Journalism and Community Issues, with support from the Foundation for a Healthy Kentucky.

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!